Opioids Flashcards
What is the typical pattern of intake of an opioid-dependent person compared to a high-efficacy stimulant dependent person?
Opiate dependent is more consistent than the binge-crash cycle of stimulant-dependent bc opiate withdrawals are so awful that they just continuously take the drug when they start to feel the high wearing off
3 endogenous opioids
Enkephalins, endorphins and dynorphins
What drug mixture gained recognition in the 1800s as a widespread use medical remedy?
Laudanum: opium + ethanol
used for teething drops for babies
What is the term used for the places people would go to smoke opium in the late 1800-early 1900s in America?
Opium dens
What tool was invented in 1853 that caused a spike in opioid use?
Hypodermic needle
What is the Harrison Act and what year was it enacted?
The ban of non-medical use of opioids; 1914
When was heroin deemed illegal?
1924
What opioid is the latest threat to OD deaths?
Fentanyl
Common routes of admin for opioids
- oral (pills, tinctures, lollipops)
- IV (heroin)
- inhalation
- intranasal (sprays)
- intramuscular
- transdermal (patches)
Where is the psychoactive substance in the opium poppy found?
White sap in the seed pod
Opioid effects and their brain regions
analgesia: SC and PAG
euphoria: VTA
respiratory depression: medulla
hypothermia: hypothalamus
catatonia: cerebellum
dream like state: frontal cortex
constipation
anti cough/nausea: medulla
itching due to histamine release
PINPOINT pupils
Which effects are lacking the most when opioid users first become tolerant?
Analgesia and euphoria
Which effects disappear the slowest in opioid tolerant users?
Constipation and respiratory depression
Which effect will never disappear no matter how tolerant an opioid user is?
Pinpoint pupils
Withdrawal symptoms of opioids (8)
Hyperalgesia Dysphoria Increased respiration Light sensitivity Violent yawning Spontaneous ejaculation Restlessness Flu like symptoms
Is there cross tolerance among all opioids?
Yes
Psychophysiological effects of opioids and their areas (3)
Shallow breathing, tiredness, pain relief (brainstem)
Fight or flight suppression: LC
Euphoria: mesolimbic pathway
How long after the last dose do withdrawal symptoms appear? How long can they last?
Appear 6-12hrs after last dose; can last 7-10 days with a peak at 2-3 days
Why is opioid addiction so heavily maintained?
Users change form chasing the high to avoiding withdrawals
Triad of symptoms of opioid overdose
- Coma
- Pinpoint pupils
- Respiratory depression
Primary medical attention for an opioid OD
Ventilation and opioid antagonist (Narcan)
What is antagonist precipitated withdrawal?
Using an opioid antagonist on someone who’s OD’d can create immediate withdrawal effects
When would someone find clonidine helpful?
When trying to gradually terminate their use of opioids in hopes of avoiding withdrawals
It’s an NE agonist so it suppresses nausea, diarrhea, cramping and sweating
What is replacement therapy?
Replacing the use of an opioid with a “less harmful” one like methadone and buprenorphine
